title: Comparison of the rate, location and size of positive surgical margins after laparoscopic and robot-assisted laparoscopic radical prostatectomy.
abstract: OBJECTIVE
  • To review and compare the rate, location and size of positive surgical margins (PSMs) after pure laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP).
  
  
  METHODS
  • The study comprised 200 patients who underwent RALP and 200 patients who underwent LRP up to January 2008. • We compared patient age, body mass index, preoperative prostate-specific antigen (PSA), preoperative stage and grade, prostate size, pathological stage and grade and neurovascular bundle preservation, as well as PSM rate, size and location. • Continuous and categorical data were compared using Student's t-test and Pearson's chi-squared test. • Multivariate regression analyses were used to identify preoperative and intraoperative predictors of PSMs.
  
  
  RESULTS
  • Although the PSM rate was similar between the two groups (LRP: 12% vs RALP: 13.5%; P = 0.76), location and size were not. PSMs after LRP were mostly at the apex (58.3%; P = 0.038), while most PSMs after RALP were posterolateral ([PL] 48%; P = 0.046). • In addition, the median margin size after RALP was significantly smaller than after LRP (RALP: 2 mm vs LRP: 3.5 mm; P = 0.041). • In univariate and multivariate analyses, tumour-node-metastasis (TNM) stage and preoperative PSA were the only independent preoperative predictors of PSMs (P = 0.044 and P = 0.01, respectively).
  
  
  CONCLUSIONS
  • The PSM risk is dependent on TNM stage and preoperative PSA and not the surgical technique, when comparing LRP with RALP.
authors.affiliation: Department of Urology, Institute Montsouris, Paris Descartes University, Paris, France.
authors.forename: Ali
authors.initials: A
authors.lastname: Kasraeian
authors.forename: Eric
authors.initials: E
authors.lastname: Barret
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chan
authors.forename: Rafael
authors.initials: R
authors.lastname: Sanchez-Salas
authors.forename: Pierre
authors.initials: P
authors.lastname: Validire
authors.forename: Xavier
authors.initials: X
authors.lastname: Cathelineau
authors.forename: Francois
authors.initials: F
authors.lastname: Rozet
authors.forename: Marc
authors.initials: M
authors.lastname: Galiano
authors.forename: Guy
authors.initials: G
authors.lastname: Vallancien
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics